SynthesisThe Indian journal of medical research2026
Focused ultrasound-induced blood-brain barrier modulation for drug delivery in recurrent glioblastoma: A systematic review.
Synthesis in The Indian journal of medical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and objectives Glioblastoma is the most aggressive primary adult central nervous system of malignancy, with a median overall survival of 12-18 months. Recurrence is almost inevitable and carries poor outcomes, with median overall survival of 2-9 months and progression-free survival of 1.5-6 months. Treatment options are limited, as locoregional therapies apply to selected patients, and systemic treatments are restricted by the blood-brain barrier. Focused ultrasound has emerged as a noninvasive method to transiently and reversibly increase blood-brain barrier permeability. This study aims to systematically evaluate the clinical efficacy and safety of focused ultrasound-mediated blood-brain barrier modulation to enhance drug delivery in recurrent glioblastoma. Methods A systematic search of PubMed, ScienceDirect, Scopus, the Cochrane Library, ClinicalTrials.gov, and Wiley Online Library identified studies published between 2015-2024. The review followed PRISMA guidelines, with risk of bias assessed using ROBINS-I and protocol registration in PROSPERO (CRD420251010548). Disagreements were resolved by consensus. Results Twelve clinical trials involving 841 patients met inclusion criteria. Focused ultrasound-mediated platforms included SonoCloud-1, SonoCloud-9, ExAblate Neuro, and NaviFUS, with 1-10 sonication sessions lasting 2.5-22 min. blood-brain barrier opening was achieved in 68-100% of procedures. Median overall survival ranged from 9.95-18 months and median progression-free survival (PFS) from 2.2-3.5 months. Several studies reported improved outcomes vs historical chemotherapy-only controls, including progression-free survival-6 rates of 42-52%. Adverse events were mostly mild and transient, with >85% graded as Grade 1 and no treatment-related mortality. Interpretation and conclusions Focused ultrasound-mediated blood-brain barrier modulation is a practical therapeutic adjunct that improves intracerebral drug penetration and might extend survival beyond traditional outcomes; providing a noninvasive approach suitable for patients where systemic dose escalation is limited by toxicity and access.
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